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Ivanova S, Vuillemin N, Hapa O, Siebenrock KA, Keel MJB, Tosounidis TH, Bastian JD. Revision of a Failed Primary Total Hip Arthroplasty following Excessive Reaming with a Medial Cup Protrusion. MEDICINA (KAUNAS, LITHUANIA) 2022; 58:medicina58091254. [PMID: 36143931 PMCID: PMC9503264 DOI: 10.3390/medicina58091254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/31/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022]
Abstract
Background and Objectives: Atraumatic intrapelvic protrusion of the acetabular component following excessive reaming of the acetabulum with a far medial positioning of the cup is a rare, but serious complication of a total hip arthroplasty (THA). This study analyzes the factors contributing to this uncommon complication and presents the outcome after the revision surgery using the Ganz reinforcement ring combined with a bone graft and plating of the posterior column and/or screws for the anterior column. Materials and Methods: A retrospective case series study with seven patients (four males, mean age 76 ± 10 years (60−86)) that underwent a revision THA within 24 ± 17 days (5−60) after an atraumatic periprosthetic acetabular fracture with a medial cup protrusion was performed. All fractures were reconstructed with a Ganz reinforcement ring and bone graft with a mean follow-up of 1.7 ± 1.7 years (0.5−5). Radiographs were evaluated for the following: (i) cup positioning immediately after the primary THA and the revision surgery, (ii) cup migration in the follow-up, and (iii) fracture healing. Results: The position of the acetabular component as assessed on the postoperative radiographs after the index surgery and before the complete medial cup protrusion showed a cup placement beyond the ilioischial line indicative of a fracture of the medial wall. The revision surgery with the reconstruction of the medial wall with a Ganz reinforcement ring combined with a bone graft restored in the presented cases the center of rotation in the horizontal direction with a statistical significance (p < 0.05). During the follow-up, there was no aseptic loosening with the relevant cup migration or significant change in the position of the acetabular cup at the final follow-up (p > 0.05) after the revision. All seven fractures and bone grafts realized a bone union until the latest follow-up. Conclusions: Following excessive reaming, the acetabular component was placed too far medially and resulted in an intrapelvic cup protrusion. An unstable cup following a fracture of the medial wall was evident on the immediate postoperative radiographs. In the case of the medial wall perforation with an intrapelvic cup protrusion after the primary THA, the reconstruction with a Ganz reinforcement ring was a successful treatment option resulting in the fracture healing and a stable cup positioning. Surgeons should be aware of that rare and probably underreported complication and restore the anatomic center of rotation by treating the defect intraoperatively.
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Affiliation(s)
- Silviya Ivanova
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Nicolas Vuillemin
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Onur Hapa
- Department of Orthopaedics and Traumatology, Faculty of Medicine Dokuz Eylül University, Izmir 35330, Turkey
| | - Klaus A. Siebenrock
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Marius J. B. Keel
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Theodoros H. Tosounidis
- Department of Orthopaedic Surgery, Medical School, University of Crete, University Hospital, 71003 Heraklion, Crete, Greece
| | - Johannes D. Bastian
- Department of Orthopaedic Surgery and Traumatology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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Revision Hip Arthroplasty in Patient with Acetabulum Migration into Subperitoneal Space-A Case Report. ACTA ACUST UNITED AC 2020; 57:medicina57010030. [PMID: 33396344 PMCID: PMC7824657 DOI: 10.3390/medicina57010030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 12/20/2020] [Accepted: 12/28/2020] [Indexed: 11/17/2022]
Abstract
Revision hip arthroplasty procedures have been extensively discussed in the literature. At the same time, discussions of the management of acetabular component protrusion into the pelvic cavity, and, more specifically, the subperitoneal space, necessitating an additional abdominal approach for the revision arthroplasty, have only been published as case reports and descriptions of transperitoneal approaches have been even rarer. This paper presents the case of a 63-year-old female patient in whom a peritoneal approach was necessary to access a migrated acetabular component. The outcome of the treatment, which represented a complex orthopedic and general surgical problem, was good. We believe that the complexity of revision hip arthroplasty in patients with protrusion of the acetabular component together with the head and proximal part of the stem of the implant into subperitoneal space calls for a careful re-analysis of the category of Type III bony acetabulum defects according to Paprosky, where the recognition of two subtypes would facilitate analysis of such cases.
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Lustig S, Mertl P, Fessy MH, Massin P. Is direct anterior approach plus dual-mobility cup a good match? Orthop Traumatol Surg Res 2018; 104:1135-1136. [PMID: 30385198 DOI: 10.1016/j.otsr.2018.09.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 08/23/2018] [Indexed: 02/02/2023]
Affiliation(s)
- Sébastien Lustig
- Groupement hospitalier Nord, hospices civils de Lyon, université Claude-Bernard Lyon I, hôpital de la Croix-Rousse, 103, boulevard de la Croix-Rousse, 69004 Lyon, France
| | - Patrice Mertl
- Service orthopédie, CHU d'Amiens - hôpital Nord, place Victor-Pauchet, 80054 Amiens, France
| | - Michel-Henri Fessy
- Service de chirurgie orthopédique, centre hospitalier Lyon Sud, bâtiment 3A, 69495 Pierre-Bénite, France
| | - Philippe Massin
- 3, rue de l'Hôtel-de-Ville, 92200 Neuilly-sur-Seine, France.
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